Healthcare Provider Details

I. General information

NPI: 1730390386
Provider Name (Legal Business Name): TEKEEMA ALICIA DIXON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/21/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 161ST ST
BRONX NY
10451-3535
US

IV. Provider business mailing address

1701 TWIN SPRINGS ROAD
WOODSTOCK MD
21163
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-2500
  • Fax:
Mailing address:
  • Phone: 240-517-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243793-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: